Re-bleeding

Beta-receptor antagonists have been found to diminish portal vein pressure in patients with cirrhosis. There is evidence that both propranolol and nadolol decrease the incidence of the first episode of bleeding from esophageal varices and decrease the mortality rate associated with bleeding in patients with cirrhosis. Nadolol in combination with isosorbide mononitrate appears to be more efficacious than sclerotherapy in preventing re-bleeding in patients who have previously bled from esophageal varices. 

Kaviani Ml, Hashemi MR, Kazemifar AR, et al. Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers A prospective, double-blind, randomized, clinical trial. Aliment Pharmacol Ther 2003 17 211-216. 

Fig. 40.3 Primarily ruptured basilar tip aneurysm with re-rupture during the insertion of the first coil, comparison between conventional CT and FD-CT. 3D-DSA, conventional DSA with subarachnoidal rebleeding and extent of re-bleeding...

Bleeding from oesophageal varices is life-threatening and occurs in 30%-40% of those with varices. There is a 75% risk of re-bleeding within two years of the first episode. 

Most endoscopists remove an adherent clot to examine the ulcer base, as an eroded vessel is detected in one out of three such cases. As there is an up to 45% risk of an ulcer with adherent clot and a visible vessel to re-bleed, this should be treated instantly. 

There are three types of endoscopic treatment available for haemostasis namely injection, thermal, and mechanical methods (Fig. 3.47). The therapeutic end-points in those with active bleeding are cessation of bleeding and to reduce or eliminate the risk of re-bleeding. The role of endoscopic treatment as a prophylaxis in non-bleeders is less clear. 

Table 3.3. Prevalence and risk of re-bleeding bleeding ulcers (Laine and Peterson 1994 ...

Whilst some authors have demonstrated that there is a reduction in the risk of re-bleeding following successful treatment (Villanueva et al. 1994),... 

Ghanayem Bl, Ahmed AE. 1986. Prevention of acrylonitrile-induced gastrointestinal bleeding by sulfhydryl compounds, atropine and cimetidine. Res Commun Chem Pathol Pharmacol 53 141-144. 

Fotiou S, Tserkezoglou A, Hadjieleftheriou G, Apostolikas N, Karydas I, Stravolemos K (1998) Tamoxifen associated uterine pathology in breast cancer patients with abnormal bleeding. Anticancer Res 18 625-629... 

If a rubber tube connected to the vacuum source and the system (or manometer) collapses, you ve had it. The system is no longer connected to the vacuum source, and as air from the bleed tube or vapor from the liquid you re distilling fills your distillation setup, the pressure in the system goes up. Occasionally test the vacuum hoses and if they collapse under vacuum, replace them with sturdier hoses that can take it. 

Johnston, G. I., Heptinstall, S., Robins, R. A., and Price, M. R. (1984) The expression of glycoproteins on single blood-platelets from healthy individuals and from patients with congenital bleeding disorders Biochem. Biophys. Res Comm 123, 1091-1098. 

Ferrazzi E, Leone FPG. Investigating abnormal bleeding on HRT or tamoxifen the role of ultrasonography. Best Pract Res Clin Obst Gynaecol 2004 18 145-56. 

Burroughs AK, Matthews K, Qadiri M, Thomas N, Kernoff P, Tuddenham E, McIntyre N. Desmopressin and bleeding time in patients with cirrhosis. BMJ (Clin Res Ed) 1985 291(6506) 1377-81. 

Schulman S, Johnsson H, Egberg N, Blomback M. DDAVP-induced correction of prolonged bleeding time in patients with congenital platelet function defects. Thromb Res 1987 45(2) 165-74. 

Elg M, Gustafsson D, Carlsson S. Antithrombotic effects and bleeding time of thrombin inhibitors and warfarin in the rat. Thromb Res 1999 94 187-197. 

Dejana E, Callioni A, Quintana A, DeGaetano G (1979) Bleeding time in laboratory animals. II - a comparison of different assay conditions in rats. Thromb Res 15 191-197 Dottl K, Ripke O (1936) Blutgerinnung und Blutungszeit. In Medizin und Chemie. Bayer, Leverkusen (Germany), pp 267-273... 

Minsker DH, Kling PJ (1977) Bleeding time is prolonged by aspirin. Thromb Res 10 619-622... 

Stella L, Donati MB, Gaetano G (1975) Bleeding time in laboratory animals. I. Aspirin does not prolong bleeding time in rats. Thromb Res 7 709-716... 

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